The global economic crisis has a significant impact on healthcare resource provision worldwide. The management of limited healthcare resources is further challenged by the high level of uncertainty in demand, which can lead to unbalanced utilisation of the available resources and a potential deterioration of patient satisfaction in terms of longer waiting times and perceived reduced quality of services. Therefore, healthcare managers require timely and accurate tools to optimise resource utility in a complex and ever-changing patient care process. An interactive simulation-based decision support framework is presented in this paper for healthcare process improvement. Complexity and different levels of variability within the process are incorporated into the process modelling phase, followed by developing a simulation model to examine the impact of potential alternatives. As a performance management tool, balanced scorecard (BSC) is incorporated within the framework to support continual and sustainable improvement by using strategic-linked performance measures and actions. These actions are evaluated by the simulation model developed, whilst the trade-off between objectives, though somewhat conflicting, is analysed by a preference model. The preference model is designed in an interactive and iterative process considering decision makers preferences regarding the selected key performance indicators (KPIs). A detailed implementation of the framework is demonstrated on an emergency department (ED) of an adult teaching hospital in north Dublin, Ireland. The results show that the unblocking of ED outflows by in-patient bed management is more effective than increasing only the ED physical capacity or the ED workforce.

Health research is one of these priorities in every economy and through this research an emphasis will be put on translational research in the context of more sustainable and efficient healthcare system (translation of operations management practices to clinical applications). Healthcare systems in general and Emergency Departments in particular around the world are facing enormous challenges in meeting the increasingly conflicting objectives of providing wide accessibility and efficiency while delivering high quality and prompt services. The proposed framework integrates simulation modeling, balanced scorecard, and multi-criteria decision analysis aiming to provide a decision support system to emergency department managers. Simulation outputs are aggregated using analytic hierarchy process (AHP) to provide marginal performance regarding the achievement of the defined strategic as well as tactical and operational objectives. Communicating the significance of investigated strategies has encouraged managers to implement the framework recommendations in the emergency department within the hospital partner.

Recently, the application of lean thinking in healthcare has grown significantly in response to rising demand caused by population growth, ageing and high expectations of service quality. However, insufficient justifications and lack of quantifiable evidence are the main obstacles to convince healthcare executives to adopt lean. Therefore, this paper presents a methodology that integrates lean tools with simulation to enhance the quality of patient care in healthcare facilities. This enables healthcare organisations to dedicate more time and effort to patient care without extra cost to the organisation or to the patient. Value stream mapping is used to identify value-added and non-value-added activities. Then, a comprehensive simulation model is developed to account for the variability and complexity of healthcare processes and to assess the gains of proposed improvement strategies. An extensive analysis of results is provided and presented to managers to illustrate the potential benefits of adapting lean practices.

Objectives: In Ireland, there has been an increase in demand for Emergency Department (ED) services with more than 1.2 million patients attending the Health Service Executive (HSE) ED annually. More than 40 percent of the patients attending ED are s waiting more than 12 hours as per HSE records. ED overcrowding and excessive patient wait times is a national and international issue that has shown to result in prolonged pain and suffering, higher mortality rates for patients and overburdened working staff (Kennedy et al, 2004). The effectiveness of an ED depends to a great extent on the quality of care and the timeliness by which healthcare professionals are able to administer care to patients. Solutions to overcrowding in ED includes; increased bed capacity, optimised discharge planning, access to diagnostics, alternatives to admission and ED attendance, long term care beds and improved community care. Lean practice is widely used within the manufacturing industry to provide timely delivery of product and ultimately to offer value for the consumer using the least resources. This idea is now being extrapolated to fit the healthcare service industry model. Lean practice assesses the effectiveness of possible solutions and focuses on each component of a system individually without determining the interaction between components. Simulation modelling is a flexible tool that can be used for evaluating various solutions and interactions within and between system components. The aim of this study is to improve patient waiting times as part of the Patient Experience Time (PET) and achieve effective satisfactory performance in a Dublin Area Teaching Hospital (DATH) ED by using a simulation based framework integrated with lean implementation. Methods: For this mixed research approach study, data was collected via field observation to document the current operation of the ED. Interviews with health care staff were conducted. The patients journey in ED was mapped and Value Stream Maps (VSMs) were developed. VSMs presents the entire set of processes so as to identify the value added (VA) and non-value added activities (NVA). Findings: The average value added time for non admitted patients was 47 minutes compared to 154 minutes non-value added time. Results of the VSM show events and conflicts that contribute to non-value added time. VSMs showed potential improvements in the processes within the major areas of ED department. Conclusion: VSM is a key tool in identifying the NVA activities which have a great impact on improving the patients waiting times. Further work will be conducted including the development of a patient experience survey to identify the areas of ED that need to be improved and to establish future VSM. The simulation model will explore the impact of potential improvements based on lean practices using the systems key performance

[1] INTERACTIVE WEB-BASED SIMULATION FOR SUPPLY CHAIN EDUCATION, 2012

Ayman Tobail, John Crowe, and Amr Arisha Book Chapter: The International Handbook of cultures of teacher education - Comparative International Issues in Curriculum and Pedagogy, VolumeChap, Pages: 125 - 150

Abstract

Knowledge economies are based on the concept of knowledge transfer between education institutes and stakeholders. In response, the significant move away from traditional teaching methods to the emerging paradigm of eLearning has become increasingly in evidence across many academic disciplines. To assist in the transition from traditional learning to eLearning, more interactive and virtually orientated teaching aids are needed. This chapter introduces a simulation-based learning framework that integrates web-based simulation and a web content management hierarchy model. Using the complex subject of supply chain management as a case study, the new framework allows users to examine various real-life strategic management scenarios, encourages group work and has remote access capabilities for distance learning. Interactive learning is facilitated using the web-based simulation portal, enabling instructors to demonstrate the complexity of decisions in multiple criteria environment and also show the users the impact of strategies on performance. Supply chain simulation creates an animated experience and better understanding of system dynamics including risk. The framework assists in the knowledge and skills transfer between third-level education institutes and their stakeholders, primarily industry partners and the wider community.